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Velumula PK, Elbakoush F, Tabb C, Farooqi A, Lulic-Botica M, Jani S, Natarajan G, Bajaj M. Breast milk vs 24% sucrose for procedural pain relief in preterm neonates: a non-inferiority randomized controlled trial. J Perinatol 2022; 42:914-919. [PMID: 35197549 DOI: 10.1038/s41372-022-01352-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To compare the pain scores between the two groups, breast milk (BM) and 24% sucrose, in preterm neonates undergoing automated heel lance for the blood draw. METHODS The study is designed as a randomized, single-blinded, non-inferiority trial. Infants born between 30 1/7weeks and 36 6/7 weeks of gestation were randomly assigned to receive either 24% sucrose or expressed BM. The Premature Infant Pain Profile-Revised (PIPP-R) was utilized to provide pain scores. RESULTS No differences were noted in the baseline characteristics between the two groups. The quantile regression estimates for PIPP-R scores during the procedure were statistically non-significant at all percentile levels of distribution (50%ile coefficient 0, 95% CI -0.49 to 0.49). CONCLUSION We conclude that BM is not inferior to 24% sucrose in providing analgesia during heel lance in moderate and late preterm infants. TRIAL REGISTRATION This trial was registered at www. CLINICALTRIALS gov (identifier NCT04898881).
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Affiliation(s)
| | - Faesal Elbakoush
- Hutzel Women's Hospital, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA
| | - Carl Tabb
- Hutzel Women's Hospital, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA
| | | | - Mirjana Lulic-Botica
- Hutzel Women's Hospital, Detroit, MI, USA.,Wayne State University, Detroit, MI, USA
| | - Sanket Jani
- Hutzel Women's Hospital, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA.,Central Michigan University, Mt. Pleasant, MI, USA
| | - Girija Natarajan
- Hutzel Women's Hospital, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA.,Central Michigan University, Mt. Pleasant, MI, USA
| | - Monika Bajaj
- Hutzel Women's Hospital, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA.,Central Michigan University, Mt. Pleasant, MI, USA
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Sasidharan R, Gupta N, Yadav B, Chawla D, Singh K, Kumarendu Singh A. 25% Dextrose Versus 24% Sucrose for Heel Lancing in Preterm Infants: A Noninferiority RCT. Pediatrics 2022; 149:186819. [PMID: 35451020 DOI: 10.1542/peds.2021-054618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare the efficacy of 25% dextrose with 24% sucrose for heel-lance analgesia in preterm infants admitted to the NICU. METHODS In this noninferiority, double-blind, randomized controlled trial, preterm infants born at 28 weeks and 0 days to 35 weeks and 6 days of gestation who were due for a scheduled heel-lance procedure were enrolled. Infants randomly assigned to the intervention arm received 0.5 mL 25% dextrose, whereas infants in the active control group received 0.5 mL 24% sucrose orally just 2 minutes before the heel-lance procedure. The primary outcome was Premature Infant Pain Profile (PIPP) score 30 seconds after the procedure. Secondary outcomes included PIPP scores at 60 and 120 seconds, PIPP-Revised scores at 30, 60, and 120 seconds, and any adverse events. RESULTS Sixty-four infants were enrolled (32 in each group). The mean (SD) PIPP score at 30 seconds was 6.41 (2.56) in the dextrose group and 7.03 (2.23) in the sucrose group (mean difference, -0.63 (95% confidence interval, -1.85 to 0.60; P = .31). The upper margin of the confidence interval did not cross the predefined noninferiority margin of 2. The mean PIPP scores at 60 (5.03 [2.18] vs 5.39 [1.48]) and 120 (4.75 [1.97] vs 4.94 [1.46]) seconds were also similar. The PIPP-Revised scores between the 2 groups at all time intervals were comparable. One infant in the intervention group had a transient coughing episode. CONCLUSIONS In preterm infants under intensive care, 25% dextrose is noninferior to 24% sucrose for heel-lance analgesia as assessed by PIPP score.
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Affiliation(s)
| | | | | | - Deepak Chawla
- Department of Neonatology, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Kuldeep Singh
- Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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3
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Lerond C, Hudry J, Zahar S, Makwana A, Schneider N. Soothing Effect of an Edible Teether: A Pilot Study in Children during Primary Dentition Age. Int J Clin Pediatr Dent 2021; 14:525-530. [PMID: 34824508 PMCID: PMC8585899 DOI: 10.5005/jp-journals-10005-2002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Irritability and discomfort are common symptoms during teething periods in infants and toddlers. Non-pharmacological remedies to relieve teething symptoms include teethers and food for chewing. However, the efficacy of such remedies for their soothing effect has been poorly investigated. Materials and methods In this home-based pilot study, the soothing effect of a novel edible teether with a slowly dissolvable texture was investigated in 12 children aged 5 to 19 months old during primary dentition age. After parents observed their child getting irritable, the child received the edible teether for an exposure duration of 15 to 20 minutes. Parental ratings of children's mood states (crankiness, stress, happiness, and calmness) were collected using visual analog scales, and child cardiac measurements (heart rate and heart rate variability) were assessed using a wearable device. The soothing effect was quantified via mood ratings and physiological calming responses as a before-after comparison using Wilcoxon signed-rank tests. Results Parents perceived their child as significantly calmer and happier, less stressed, and marginally less cranky after edible teether exposure than before. The child cardiac variables showed no significant changes; however, exposure to the teether induced a marginal increase in HR within normal ranges, potentially indicating a stimulation effect. Conclusion The pilot study provides the first insight on the soothing effect of a novel edible teether on parent-reported mood states in young children during primary dentition age. Further research is needed to understand the relative contribution of the different components of an edible teether to the observed effects, such as texture and exposure duration, and to demonstrate its efficacy against a control product. Trial registration Swiss registry of clinical trial: CER-VD 2019-02155. How to cite this article Lerond C, Hudry J, Zahar S, et al. Soothing Effect of an Edible Teether: A Pilot Study in Children during Primary Dentition Age. Int J Clin Pediatr Dent 2021;14(4):525–530.
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Affiliation(s)
- Clara Lerond
- Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé SA, Vers-chez-les-Blanc, Lausanne, Switzerland
| | - Julie Hudry
- Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé SA, Vers-chez-les-Blanc, Lausanne, Switzerland
| | - Sélima Zahar
- Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé SA, Vers-chez-les-Blanc, Lausanne, Switzerland
| | - Aidan Makwana
- Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé SA, Vers-chez-les-Blanc, Lausanne, Switzerland
| | - Nora Schneider
- Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé SA, Vers-chez-les-Blanc, Lausanne, Switzerland
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Barandouzi ZA, Keshavarz M, Montazeri A, Ashayeri H, Rajaei Z. Comparison of the analgesic effect of oral sucrose and/or music in preterm neonates: A double-blind randomized clinical trial. Complement Ther Med 2019; 48:102271. [PMID: 31987233 DOI: 10.1016/j.ctim.2019.102271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/19/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To compare the analgesic effects of sucrose, music, and their combination on venipuncture's pain in preterm neonates. METHODOLOGY A double-blinded randomized control trial conducted at a Neonatal Intensive Care Unit (NICU) affiliated to Tehran University of Medical Sciences (TUMS) in Tehran, Iran. One hundred and twenty preterm neonates were randomly allocated into three experimental (sucrose, music and combination of sucrose and music) and one control groups (n = 30 for each group). Two minutes before the venipuncture, 0.5 ml of oral 24% sucrose was provided for the sucrose and combination groups. The combination group additionally received lullaby music as same as the music group. The control group had headphones without playing music and received sterile water. Blinded assessment of the Premature Infant Pain Profile (PIPP) was performed before and during venipuncture, as well as 30 s and 10 min and 10 min after its completion. RESULTS The pain scores during venipuncture in the sucrose and combination groups were significantly lower than the control group (p = .003, p < .001, respectively) but not in the music group. Thirty seconds after the end of the venipuncture, the pain score in the three intervention groups was significantly lower than the control group (sucrose, music and, combination group, p < .001, p = .009, p < .001, respectively). Ten min after the venipuncture, there was no significant difference in pain scores among the four groups. CONCLUSION Music could relief pain 30 s after the venipuncture completion but not during the venipuncture. A more prolonged period of playing music is recommended to evaluate the analgesic effects of music in preterm neonates in future studies.
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Affiliation(s)
| | - Maryam Keshavarz
- Midwifery and Reproductive Health Department, School of Nursing & Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Ali Montazeri
- Mental Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran.
| | - Hassan Ashayeri
- Rehabilitation Department, Iran University of Medical Sciences, Tehran, Iran.
| | - Zahra Rajaei
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
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Clinical Practice Guideline: Needle-Related or Minor Procedural Pain in Pediatric Patients. J Emerg Nurs 2019; 45:437.e1-437.e32. [DOI: 10.1016/j.jen.2019.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Chichester M, Wool C. The Meaning of Food and Multicultural Implications for Perinatal Palliative Care. Nurs Womens Health 2016; 19:224-35. [PMID: 26058905 DOI: 10.1111/1751-486x.12204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Feeding an infant is a bonding experience for parents, particularly for women from cultures in which breastfeeding is the norm. When an infant is unexpectedly ill, or his or her life is expected to be brief, challenges surrounding infant feeding can occur. Regardless of ethnicity or culture, parents facing the death of their infant have difficult decisions to make and need time to process those decisions. Given the social, cultural and spiritual nature of food and water, withdrawing or withholding nutrition and/or hydration for infants can be one of the most difficult decisions for parents. This article considers the clinical and cultural ramifications of infant feeding decisions when a shift occurs from curative interventions to palliative care.
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Mooney-Leber SM, Brummelte S. Neonatal pain and reduced maternal care: Early-life stressors interacting to impact brain and behavioral development. Neuroscience 2016; 342:21-36. [PMID: 27167085 DOI: 10.1016/j.neuroscience.2016.05.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/22/2016] [Accepted: 05/02/2016] [Indexed: 12/21/2022]
Abstract
Advances in neonatal intensive care units (NICUs) have drastically increased the survival chances of preterm infants. However, preterm infants are still exposed to a wide range of stressors during their stay in the NICU, which include painful procedures and reduced maternal contact. The activation of the hypothalamic-pituitary-adrenal (HPA) axis, in response to these stressors during this critical period of brain development, has been associated with many acute and long-term adverse biobehavioral outcomes. Recent research has shown that Kangaroo care, a non-pharmacological analgesic based on increased skin-to-skin contact between the neonate and the mother, negates the adverse outcomes associated with neonatal pain and reduced maternal care, however the biological mechanism remains widely unknown. This review summarizes findings from both human and rodent literature investigating neonatal pain and reduced maternal care independently, primarily focusing on the role of the HPA axis and biobehavioral outcomes. The physiological and positive outcomes of Kangaroo care will also be discussed in terms of how dampening of the HPA axis response to neonatal pain and increased maternal care may account for positive outcomes associated with Kangaroo care.
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Affiliation(s)
- Sean M Mooney-Leber
- Department of Psychology, Wayne State University, Detroit, MI, United States
| | - Susanne Brummelte
- Department of Psychology, Wayne State University, Detroit, MI, United States.
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Messerer B, Krauss-Stoisser B, Urlesberger B. [Non-pharmaceutical measures, topical analgesics and oral administration of glucose in pain management: Austrian interdisciplinary recommendations on pediatric perioperative pain management]. Schmerz 2015; 28:31-42. [PMID: 24550025 DOI: 10.1007/s00482-014-1391-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Non-pharmaceutical procedures are increasingly being used in pediatric pain therapy in addition to pharmaceutical procedures and have a supporting function. This article describes the non-pharmaceutical procedures which have an influence on perioperative and posttraumatic pain in children and adolescents. Prerequisites for every adequate pain therapy are affection, imparting a feeling of security, distraction and the creation of a child-oriented environment. Topical analgesics are indicated for application to intact skin for surface anesthesia. For a safe use consideration must be given to the duration of application, the dose and the maximum area of skin treated in an age-dependent manner. For simple but painful procedures in premature infants, neonates and infants, pain can be effectively reduced by the oral administration of glucose. The positive effect is guaranteed particularly for the use in a once only pain stimulation. Non-nutritive sucking, swaddling, facilitated tucking and kangaroo mother care, for example can be used as supportive measures during slightly painful procedures. There is insufficient evidence for a pain reducing effect in older infants and small children. Physical therapeutic procedures can be used as accompanying measures for acute pain and are individually adapted. However, the limited amount of currently available data is insufficient to make a critical scientific assessment of the individual measures. The effects can, however, be observed in the daily routine practice. Psychological methods can facilitate coping with pain. In situations with mental and psychiatric comorbidities or psychosocial impairment, a psychologist should be consulted. Acupuncture and hypnosis are also a meaningful addition within the framework of multimodal pain therapy.
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Affiliation(s)
- B Messerer
- Universitätsklinik für Anästhesiologie und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 29, 8036, Graz, Österreich,
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Toy-mediated distraction: clarifying the role of agent of distraction and preneedle distress in toddlers. Pain Res Manag 2014; 18:197-202. [PMID: 23936893 DOI: 10.1155/2013/392125] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Distraction has recently gained attention as a technique that may help reduce acute pain in infants and toddlers; however, results remain equivocal. It appears that these mixed results stem from a variety of methodological differences with regard to how distraction is implemented. OBJECTIVES To offer more definitive conclusions regarding the efficacy and mechanisms of distraction for pain management during infancy. Specifically, the goal was to examine whether the agent of distraction (i.e., the specific person conducting the distraction) and preneedle distress behaviours impact the efficacy of distraction when toddlers were held by parents. METHODS A total of 99 toddlers were randomly assigned to one of three conditions (typical care, research assistant-directed distraction or parent-directed distraction). Toddler distress behaviours were assessed pre- and postneedle. Toddlers were further grouped according to distress behaviours preneedle (low⁄no distress versus high distress). Parental soothing behaviours were also assessed as a manipulation check. RESULTS Toddler postneedle pain did not significantly differ among groups. However, toddlers who were distressed preneedle displayed significantly more pain postneedle, regardless of the treatment group. There were no significant interactions between treatment group and preneedle distress behaviours. CONCLUSIONS These results suggest that, when being held by a parent, distraction using a toy does not result in lower pain scores in the context of immunization, regardless of who offers the distraction. Furthermore, these findings raise the notion that if clinicians ensured toddlers were regulated before attempting an immunization, postneedle pain may be significantly reduced.
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Roegiers É, Alderson M, Van Durme T. Les pratiques entourant les soins de développement : exploration des barrières à l'adoption et stratégies proposées par les experts pour les pallier. Rech Soins Infirm 2013. [DOI: 10.3917/rsi.115.0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
Regardless of age, health care professionals have a professional and ethical obligation to provide safe and effective analgesia to patients undergoing painful procedures. Historically, newborns, particularly premature and sick infants, have been undertreated for pain. Intubation of the trachea and mechanical ventilation are ubiquitous painful procedures in the neonatal intensive care unit that are poorly assessed and treated. The authors review the use of sedation and analgesia to facilitate endotracheal tube placement and mechanical ventilation. Controversies regarding possible adverse neurodevelopmental outcomes after sedative and anesthetic exposure and in the failure to treat pain is also discussed.
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Bellieni CV, Taddio A, Linebarger JS, Lantos JD. Should an IRB approve a placebo-controlled randomized trial of analgesia for procedural pain in neonates? Pediatrics 2012; 130:550-3. [PMID: 22891235 PMCID: PMC4074620 DOI: 10.1542/peds.2011-2910] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Anna Taddio
- Faculty of Pharmacy, University of Toronto, Toronto, Canada; and
| | - Jenni S. Linebarger
- Department of Pediatrics, University of Missouri at Kansas City, Kansas City, Missouri
| | - John D. Lantos
- Department of Pediatrics, University of Missouri at Kansas City, Kansas City, Missouri
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